Matrella E, Valatas V, Notas G, Roumpaki H, Xidakis C, Hadzidakis A, Mouzas I, Kouroumalis E
Department of Gastroenterology, University of Crete, School of Medicine, Heraklion Crete, Greece.
Aliment Pharmacol Ther. 2001 Jun;15(6):857-64. doi: 10.1046/j.1365-2036.2001.00996.x.
Evidence exists that somatostatin and octreotide might have different effects on hepatic haemodynamics.
The investigation of the effects of somatostatin and its octapeptide analogue, octreotide, on sinusoidal pressure measured by the wedged hepatic venous pressure in patients with cirrhosis or chronic hepatitis and the correlation with the levels of hepatic vein NO.
Patients were randomly assigned to receive an injection of either 250 microg somatostatin (n=14: cirrhosis six, chronic hepatitis eight) or an injection of 125 microg octreotide (n=19: cirrhosis nine, chronic hepatitis 10) during hepatic vein catheterization. Baseline wedged hepatic venous pressure was measured, followed by measurements at 2, 5, 10 and 15 min after the injection of the drug. Nitrites/nitrates of the hepatic vein were measured before the injection and after 15 min.
Both agents showed a similar qualitative but a different quantitative haemodynamic profile. No change in the wedged hepatic venous pressure was observed during the first 2 min after the injection of both drugs. This was followed by a decrease: 18% at 5 min (N.S.), 23% at 10 min (P < 0.01) and 24% at 15 min (P < 0.01) for somatostatin. Octreotide induced a relatively smaller decrease in the wedged hepatic venous pressure: 8% at 5 min (N.S.), 20% at 10 min (P < 0.01) and 16% at 15 min (N.S.). Further analysis of the sub-groups of cirrhotic and chronic hepatitis patients revealed a different effect. In the sub-group of cirrhotic patients, somatostatin caused a maximum decrease of 34% at 15 min post-injection (P < 0.01), but octreotide failed to produce a significant change on the wedged hepatic venous pressure. In contrast, no change was observed in chronic hepatitis patients with either drug. No change in the hepatic vein concentration of NO after treatment was observed with either somatostatin or octreotide. Moreover, no correlation of the levels of NO with the wedged hepatic venous pressure values was found.
This study shows that somatostatin is more effective than octreotide in acutely reducing the wedged hepatic venous pressure after bolus injection and the observed change is probably mediated by a NO-independent mechanism.
有证据表明生长抑素和奥曲肽对肝脏血流动力学可能有不同影响。
研究生长抑素及其八肽类似物奥曲肽对肝硬化或慢性肝炎患者通过肝静脉楔压测量的肝窦压力的影响，以及与肝静脉一氧化氮水平的相关性。
在肝静脉插管期间，患者被随机分配接受注射250微克生长抑素（n = 14：肝硬化6例，慢性肝炎8例）或125微克奥曲肽（n = 19：肝硬化9例，慢性肝炎10例）。测量基线肝静脉楔压，然后在注射药物后2、5、10和15分钟进行测量。在注射前和15分钟后测量肝静脉亚硝酸盐/硝酸盐水平。
两种药物均显示出相似的定性但不同的定量血流动力学特征。注射两种药物后的前2分钟内，肝静脉楔压未观察到变化。随后出现下降：生长抑素在5分钟时下降18%（无统计学意义），10分钟时下降23%（P < 0.01），15分钟时下降24%（P < 0.01）。奥曲肽引起的肝静脉楔压下降相对较小：5分钟时下降8%（无统计学意义），10分钟时下降20%（P < 0.01），15分钟时下降16%（无统计学意义）。对肝硬化和慢性肝炎患者亚组的进一步分析显示出不同的效果。在肝硬化患者亚组中，生长抑素在注射后15分钟时最大下降34%（P < 0.01），但奥曲肽未能使肝静脉楔压产生显著变化。相反，慢性肝炎患者使用两种药物均未观察到变化。生长抑素或奥曲肽治疗后，肝静脉一氧化氮浓度均未观察到变化。此外，未发现一氧化氮水平与肝静脉楔压值之间存在相关性。
本研究表明，在静脉推注后急性降低肝静脉楔压方面，生长抑素比奥曲肽更有效，且观察到的变化可能由非一氧化氮依赖机制介导。
